Remote monitoring offers promise for geriatric patients
With the greater emphasis on care in the home and other living environments, geriatric providers will need alternate ways of monitoring disease, activity, response to therapy and patient safety, according to an article by Hyun Gu Kang, PhD, and colleagues in the October edition of Journal of the American Geriatrics Society.
“Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurements of physiological and sociological data for use in geriatrics care,” the authors stated. Monitoring technology also can aid in chronic disease management to maximize health, prevent complications and conserve healthcare resources, while allowing older adults to live independently for longer and “age in place” and extending healthcare resources to more people, they wrote.
But many hurdles also exist: “Technology is often developed without proper understanding of specific needs of older adults or what would be useful to clinicians. Patients, particularly older adults, are concerned about privacy, unfamiliarity with technology, and potential decrease in social contact.
"Many providers are concerned about potential information overload, with irrelevant information and technology detracting from interpersonal care. The lack of funding for instrumentation, data collection, and interpretation of data can also be prohibitive,” the article states.
“Concerns have been raised about the possibility that monitoring technology could be used to replace caregiver–patient interactions and thus reduce the therapeutic aspect of social contact for the older patients, who are especially vulnerable to social isolation,” stated the article. “Nevertheless, an in situ home monitoring system can be a platform to provide more, not less, contact with the healthcare system, particularly in low-access settings, provided that the technology is designed with this concern in mind and not as a substitute for skilled caregivers.”
Information overload is a concern because monitoring technology can create large amounts of information that may have limited clinical value, the authors wrote. Therefore, “the clinician needs to specify how a data stream should be tailored appropriately to the needs of a specific patient, interpret the incoming data and take appropriate actions.”
The article cites several technical issues. Among them are the need for a reliable system architecture and data infrastructure, to handle growing communication and storage needs. Various ways to transmit data need to be considered, and standardization is important for future upgrades and compatibility. In addition, internet-based communications are subject to HIPAA requirements for information security, the authors noted.
Other issues are “hardware incompatibility, lack of cellphone coverage, power outages and unexpected automated operating system software updates requiring computer reboots can easily hamper implementation of monitoring technologies,” they wrote.
The authors made the following recommendations:
“Recent developments of sensors, data recorders, and communication networks allow the unprecedented measurements of physiological and sociological data for use in geriatrics care,” the authors stated. Monitoring technology also can aid in chronic disease management to maximize health, prevent complications and conserve healthcare resources, while allowing older adults to live independently for longer and “age in place” and extending healthcare resources to more people, they wrote.
But many hurdles also exist: “Technology is often developed without proper understanding of specific needs of older adults or what would be useful to clinicians. Patients, particularly older adults, are concerned about privacy, unfamiliarity with technology, and potential decrease in social contact.
"Many providers are concerned about potential information overload, with irrelevant information and technology detracting from interpersonal care. The lack of funding for instrumentation, data collection, and interpretation of data can also be prohibitive,” the article states.
“Concerns have been raised about the possibility that monitoring technology could be used to replace caregiver–patient interactions and thus reduce the therapeutic aspect of social contact for the older patients, who are especially vulnerable to social isolation,” stated the article. “Nevertheless, an in situ home monitoring system can be a platform to provide more, not less, contact with the healthcare system, particularly in low-access settings, provided that the technology is designed with this concern in mind and not as a substitute for skilled caregivers.”
Information overload is a concern because monitoring technology can create large amounts of information that may have limited clinical value, the authors wrote. Therefore, “the clinician needs to specify how a data stream should be tailored appropriately to the needs of a specific patient, interpret the incoming data and take appropriate actions.”
The article cites several technical issues. Among them are the need for a reliable system architecture and data infrastructure, to handle growing communication and storage needs. Various ways to transmit data need to be considered, and standardization is important for future upgrades and compatibility. In addition, internet-based communications are subject to HIPAA requirements for information security, the authors noted.
Other issues are “hardware incompatibility, lack of cellphone coverage, power outages and unexpected automated operating system software updates requiring computer reboots can easily hamper implementation of monitoring technologies,” they wrote.
The authors made the following recommendations:
- Geriatrics providers must have a greater role in the development and use of these technologies while remaining at the forefront of deciding what is best for patients.
- Robust technology, designed with ease of use by older adults in mind, is needed to provide safety, reliability, and security for providing patient care. Real-world testing and clinical trials should be promoted and supported earlier in the design stage as well.
- Policy must be guided by determining the cost-effectiveness of providing care using in situ monitoring. Funding options need to be explored further.
- Regulations for protected health information and licensure policies need to be congruent among different caregiver groups.